Research and analysis

Appendix B: semi-structured interview findings, themes and implications

Published 23 July 2026

Appendix B summarises the main themes that were generated from individual interviews, highlighting participants’ perspectives on accuracy, instructions, international practices, choice, follow-up, and the rationale for introducing HPV self-sampling. The findings reflect a range of opinions and preferences, and illustrate how clear, transparent communication and genuine choice are central to building trust and confidence in new screening options.

Communicating accuracy and efficacy

Understanding how accurate human papillomavirus (HPV) self-sampling is compared to clinician-taken sampling was a central concern across all interviews. Participants expressed a need for clarity on effectiveness to build confidence in the method, especially when considering a new and unfamiliar approach. There was a consistent desire to understand not just whether self-sampling “works”, but whether it can be trusted to perform at the same standard as tests carried out by professionals. The relational framing of accuracy, not just in terms of statistics but in relation to what people already know, shaped much of the discussion.

Interviewees repeatedly called for direct comparisons between self- and clinician-taken sampling, framed in clear, accessible language. For example, one participant shared, “I think I’d like the choice myself… because then at least I would feel, I don’t know why, but I think that it kind of gives me that reassurance that in their eyes they’re the same.”

Another remarked that even if the test was slightly less accurate, it could still be valid, provided the difference was openly acknowledged: “It’s fine if it’s not perfect, but just say so. Then I can weigh it up properly.” This highlights the importance of communicating the trade-offs rather than attempting to focus on certainty.

Participants also drew mental analogies to other home testing experiences, especially those made commonplace during the COVID-19 pandemic or through bowel cancer screening. These references helped ground their expectations. As one put it, “It’s like the COVID test - at first I didn’t know how to do it, but you get used to it. So if it’s similar, that makes me feel better.” These analogies suggest that tapping into familiar health behaviours can support trust in new initiatives like HPV self-sampling.

Participants advocated for transparent and comparative communication that respected their ability to assess risks and benefits. The emphasis was on informed decision-making, not on persuasion. As one participant stated, “Even if it’s 90% compared to 95%, I might still choose it. I just want to know that’s what I’m choosing.”

Clear and supportive instructions

Participants placed substantial emphasis on the quality and delivery of instructional materials, viewing them as a core determinant of confidence and comfort. The word “easy” recurred as a shorthand for emotional reassurance, technical usability, and procedural safety. As one person shared, “‘Easy’ is a word that would make me feel confident in considering self-sampling.” The assumption was that simplicity in instructions would reduce anxiety and help overcome the absence of a healthcare professional.

People consistently requested step-by-step guides that included not just text but visual aids, diagrams, and ideally short videos. Some suggested animations would be particularly helpful, especially for users who might be doing the test for the first time. One interviewee explained, “A sort of step-by-step guide as well of how it would work at home and the process of sending it off. So basically, just a complete guide to the process too would be quite good.” “I’d like it to be broken down almost in like baby terms, because not everybody can absorb the whole medical transcript of information.” These responses suggest that the presentation and different formats of communication, not just content, might play a role in decision making and uptake.  

Importantly, participants also spoke about real-time reassurance during testing. Some proposed having reference points or visual cues to confirm that they were following the procedure correctly. This reflects a broader point: participants want to feel capable, and good instructions help bridge the gap between unfamiliarity and competence.

Overall, instructions were seen not merely as functional tools, but as a way to convey transparency and inclusion, reinforcing both the credibility of the method and the confidence of the user.

International practices as reassurance

Many participants responded favourably to learning that HPV self-sampling is already being used in other countries. This information helped validate the method by providing external precedent and some reassurance that it is not entirely new or untested.

Some people associated the use of self-sampling in other countries with progress. As one said, “If another country has moved forward and it’s proven successful, yeah, I think that that’s a really good thing to know.” Another commented, “It makes me think, well bloody hell, let’s get on with it.” Knowing that other healthcare systems had trialled and approved self-sampling offered a sense of social proof and normalisation, making participants feel more confident about its introduction in the UK. However, this did not imply that participants viewed UK healthcare as outdated; rather, international examples were seen as additional reassurance

Some participants expressed surprise and enthusiasm upon learning about international practices. One said, “Wow. Yeah, I think it would actually be great to know that because I didn’t know that.” Another added, “That gives me a bit more confidence that this is the right thing for me to be doing. And if other people are following that, then you know it does kind of help.”.

However, people also made it clear that this information should not be tokenistic or vague. They preferred specific and credible examples (named countries, established data, and cited programmes).

Framing the offer: choice versus recommendation

In line with the UK’s approach to screening where participation is generally presented as a choice, participants voiced a strong preference for HPV self-sampling to be offered as a neutral, informed option rather than as a recommended or default pathway. They wanted both self-sampling and clinician-taken sampling to be presented side by side, with equal emphasis and legitimacy. This approach, they explained, fostered a sense of control and empowerment that they felt was often missing from screening experiences. One participant explained, “Being able to have the choice is more beneficial. Because then you feel more in control of your own health. Rather than them telling you need to do this.” Another echoed, “I’d prefer to be given the neutral choice because again, it’s that whole pressure thing. Someone could feel, ‘Oh, I should be doing that one’ and not be comfortable.”

Participants also suggested that offering choice would reinforce perceptions of equivalence between the options. As one said, “I think I’d like the choice myself… it gives me that reassurance that in their eyes they’re the same.” When people feel they are being nudged rather than supported, they are more likely to disengage.

Ultimately, the interviews revealed that choice enhances both acceptance and confidence, provided that each option is explained clearly and offered with equal value.

Managing expectations: clinician follow-up

Participants generally accepted the idea that clinician-based follow-up might be necessary after self-sampling. Rather than viewing this as a flaw or inconvenience, many saw it as reassuring. A sign that the screening process would still offer a second layer of ‘protection’. Several described it as “logical” or “the next step,” if HPV was detected. As one participant put it, “You’d only have to go if there was a concern. You wouldn’t be going through that process unnecessarily.”

For some, the knowledge that a follow-up might be required increased their confidence in self-sampling. They perceived it as part of a robust system designed to flag concerns early and escalate when needed. One person commented, “This wouldn’t sway my decision to self-sample. It would reassure me even more that there is that kind of additional check if something is found.”

However, participants were clear that the potential for a follow-up must be explained from the outset. They wanted a transparent view of the full journey, with no surprises or gaps in knowledge. As one interviewee stated, “I would just assume that that would be the standard procedure anyway” but others warned that not everyone would make that assumption, especially without explicit guidance. This speaks to the need for a ‘no surprises’ communication approach, especially when asking people to try a new method of screening.

Participants recommended that communications include a simple timeline showing when to expect results, when referral for clinician-taken cervical screening might be triggered, and what a follow-up visit would involve. This was particularly important for individuals with prior trauma or with medical anxiety. In summary, while follow-ups were seen positively, their effectiveness as reassurance hinges on proactive, clear messaging. Confidence is best supported when people feel informed and prepared, not reactive or confused.

Curiosity without concern

While many participants expressed curiosity about why HPV self-sampling was being introduced now, this was not a critical factor in their decision-making. Most were content to infer their own explanations, often positive and rational ones, and did not feel that a specific rationale was necessary for them to trust the offer. As one put it, “It’s here now, isn’t it? The moving forward, that’s important.”

Participants speculated on several plausible motivations, including medical innovation, NHS efficiency, and expanded patient convenience. These assumptions generally worked in favour of HPV self-sampling. For example, one said, “I just think maybe things have moved medically forward.” Another framed it as system-level support: “It would be about relieving pressure on GPs, so an ethical thing for the NHS to make that clear.” These attributions suggest that participants are willing to see system change as progressive if it is presented transparently and respectfully.

However, a few interviewees raised the possibility that self-sampling might be driven by cost-cutting, which generated mixed responses. For some, this was acceptable if quality was maintained: “If it’s about cost cutting, it’s okay provided that you’re being offered an equally good alternative.” This reinforces earlier focus group themes about credibility and comparison. Cost efficiency is tolerated when people believe their care is not being compromised.

Overall, ‘why now?’ was not perceived as a barrier to trust, but as a valuable contextual layer. Participants appreciated knowing the rationale when offered, but did not rely on it to feel comfortable. This suggests that while motivation messaging may not be central to behaviour change, it still contributes to the tone and transparency of the communication - especially for those already sceptical of changes to the screening programme.